Inconsistencies in laboratory investigations of hypertension in a young woman taking ethinylestradiol/drospirenone association

ABSTRACT

Case presentation

A 34-year-old woman presented to the emergency department for arterial hypertension. Blood analysis requested by the endocrinologist showed very high level of aldosterone (1805 ng/L, normal values: <264 ng/L) and high level of renin activity (2.8 ng/mL/h, normal values: 0.1–2.0 ng/mL/h). The patient reported the use of Yasmin® (ethinylestradiol 30 µg/drospirenone 3 mg) continuously (without hormone-free week between cycles) as oral contraception. Medical imaging examinations revealed no anomaly in the kidneys and the adrenal glands. On the endocrinologist advice, patient stopped the intake of Yasmin®. Aldosterone and renin levels were measured several times after the discontinuation of the oral contraception and a diminution of these levels was observed with a complete normalization of both levels 26 days after the synthetic hormones discontinuation.

Discussion

The literature shows that ethynilestradiol/drospirenone association can interfere with the renin-angiotensin-aldosterone system and increase the levels of aldosterone and/or renin. We reported here a clinical case illustrating the significant impact of this medication on the renin-angiotensin-aldosterone axis of a young woman. However, this association is not listed among the drugs interfering with the aldosterone and renin-level measurements.

Conclusion

Considering the data in the literature and our clinical case, we suggest adding drospirenone and the ethinylestradiol/drospirenone association in the list of drugs interfering with aldosterone and renin level determination.

KEYWORDS:

• Hypertension
• hyperaldosteronism
• high renin level
• drospirenone
• ethinylestradiol

Acknowledgements

Authors would like to thanks Drs Castiglione and Grifnée for their careful reviewing of the paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

PD wrote the main manuscript text. PD, CLG and EC assayed the biological samples of the patient. LV performed the clinical examination of the patient. All authors reviewed the manuscript.

Consent to participate

Patient gave her consent for publication.

Data availability statement

There is no supplemental data to share.